A prospective evaluation of the use of routine repeat cranial CT scans in patients with intracranial hemorrhage and GCS score of 13 to 15
Scheduled repeat head computed tomography after mild traumatic brain injury has been shown to have limited use for predicting the need for an intervention. We hypothesized that repeat computed tomography in persons with intracranial hemorrhage and a Glasgow Coma Scale (GCS) score of 13 to 15, withou...
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| Veröffentlicht in: | The journal of trauma and acute care surgery 2012-09, Vol.73 (3), p.685-688 |
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| container_title | The journal of trauma and acute care surgery |
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| creator | AbdelFattah, Kareem R Eastman, Alexander L Aldy, Kim N Wolf, Steven E Minei, Joseph P Scott, William W Madden, Christopher J Rickert, Kim L Phelan, Herb A |
| description | Scheduled repeat head computed tomography after mild traumatic brain injury has been shown to have limited use for predicting the need for an intervention. We hypothesized that repeat computed tomography in persons with intracranial hemorrhage and a Glasgow Coma Scale (GCS) score of 13 to 15, without clinical progression of neurologic symptoms, does not impact the need for neurosurgical intervention or discharge GCS scores.
This prospective cohort study followed all patients presenting to our urban Level I trauma center with intracranial hemorrhage and a GCS score of 13 to 15 from February 2010 to December 2010. Subjects were divided into two groups: those in whom repeat CT scans were performed routinely (ROUTINE) and those in whom they were performed selectively (SELECTIVE) based on changes in clinical examination. CT scanning decisions were made at the discretion of the neurosurgical service attending physician.
One hundred forty-five patients met the inclusion criteria (ROUTINE, n = 92; SELECTIVE, n = 53). Group demographics, including age, sex, and presenting GCS score were not significantly different. Of SELECTIVE patients, six (11%) required a repeat head computed tomography for a neurologic change, with one having a radiographic progression of hemorrhage (16%) versus 26 (28%) of 92 in the ROUTINE group showing a radiographic progression. No patient in either group required medical or neurosurgical intervention based on repeat scan. The number of CT scans performed differed between the two groups (three scans in ROUTINE vs. one scan in SELECTIVE, p < 0.001), as did the intensive care unit (2 days vs. 1 day, p < 0.001) and hospital (5 days vs. 2 days, p < 0.001) lengths of stay. Discharge GCS score was similar for both groups (15 vs. 15, p = 0.37). One death occurred in the SELECTIVE group, unrelated to intracranial findings. The negative predictive value of a repeat CT scan leading to neurosurgical intervention with no change in clinical examination was 100% for both groups.
A practice of selective repeat head CT scans in patients with traumatic brain injury admitted with a GCS score of 13 to 15 decreases use of the test and is associated with decreased hospital length of stay, without impacting discharge GCS scores.
Diagnostic study, level II. |
| doi_str_mv | 10.1097/TA.0b013e318265ccd9 |
| format | Article |
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This prospective cohort study followed all patients presenting to our urban Level I trauma center with intracranial hemorrhage and a GCS score of 13 to 15 from February 2010 to December 2010. Subjects were divided into two groups: those in whom repeat CT scans were performed routinely (ROUTINE) and those in whom they were performed selectively (SELECTIVE) based on changes in clinical examination. CT scanning decisions were made at the discretion of the neurosurgical service attending physician.
One hundred forty-five patients met the inclusion criteria (ROUTINE, n = 92; SELECTIVE, n = 53). Group demographics, including age, sex, and presenting GCS score were not significantly different. Of SELECTIVE patients, six (11%) required a repeat head computed tomography for a neurologic change, with one having a radiographic progression of hemorrhage (16%) versus 26 (28%) of 92 in the ROUTINE group showing a radiographic progression. No patient in either group required medical or neurosurgical intervention based on repeat scan. The number of CT scans performed differed between the two groups (three scans in ROUTINE vs. one scan in SELECTIVE, p < 0.001), as did the intensive care unit (2 days vs. 1 day, p < 0.001) and hospital (5 days vs. 2 days, p < 0.001) lengths of stay. Discharge GCS score was similar for both groups (15 vs. 15, p = 0.37). One death occurred in the SELECTIVE group, unrelated to intracranial findings. The negative predictive value of a repeat CT scan leading to neurosurgical intervention with no change in clinical examination was 100% for both groups.
A practice of selective repeat head CT scans in patients with traumatic brain injury admitted with a GCS score of 13 to 15 decreases use of the test and is associated with decreased hospital length of stay, without impacting discharge GCS scores.
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This prospective cohort study followed all patients presenting to our urban Level I trauma center with intracranial hemorrhage and a GCS score of 13 to 15 from February 2010 to December 2010. Subjects were divided into two groups: those in whom repeat CT scans were performed routinely (ROUTINE) and those in whom they were performed selectively (SELECTIVE) based on changes in clinical examination. CT scanning decisions were made at the discretion of the neurosurgical service attending physician.
One hundred forty-five patients met the inclusion criteria (ROUTINE, n = 92; SELECTIVE, n = 53). Group demographics, including age, sex, and presenting GCS score were not significantly different. Of SELECTIVE patients, six (11%) required a repeat head computed tomography for a neurologic change, with one having a radiographic progression of hemorrhage (16%) versus 26 (28%) of 92 in the ROUTINE group showing a radiographic progression. No patient in either group required medical or neurosurgical intervention based on repeat scan. The number of CT scans performed differed between the two groups (three scans in ROUTINE vs. one scan in SELECTIVE, p < 0.001), as did the intensive care unit (2 days vs. 1 day, p < 0.001) and hospital (5 days vs. 2 days, p < 0.001) lengths of stay. Discharge GCS score was similar for both groups (15 vs. 15, p = 0.37). One death occurred in the SELECTIVE group, unrelated to intracranial findings. The negative predictive value of a repeat CT scan leading to neurosurgical intervention with no change in clinical examination was 100% for both groups.
A practice of selective repeat head CT scans in patients with traumatic brain injury admitted with a GCS score of 13 to 15 decreases use of the test and is associated with decreased hospital length of stay, without impacting discharge GCS scores.
Diagnostic study, level II.</description><subject>Adult</subject><subject>Cohort Studies</subject><subject>Craniotomy - methods</subject><subject>Craniotomy - mortality</subject><subject>Critical Illness</subject><subject>Diagnostic Tests, Routine</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Glasgow Coma Scale</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Injury Severity Score</subject><subject>Intracranial Hemorrhage, Traumatic - diagnostic imaging</subject><subject>Intracranial Hemorrhage, Traumatic - etiology</subject><subject>Intracranial Hemorrhage, Traumatic - mortality</subject><subject>Intracranial Hemorrhage, Traumatic - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patient Selection</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>Statistics, Nonparametric</subject><subject>Survival Rate</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Tomography, X-Ray Computed - utilization</subject><subject>Trauma Centers</subject><subject>Treatment Outcome</subject><subject>Unnecessary Procedures</subject><subject>Young Adult</subject><issn>2163-0755</issn><issn>2163-0763</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUU1LxDAQDaLoov4CQXL0smuSaZLmuCy6CoIH13NJ06mtdNuapIo_wX9t_NqDc5nH8N4b5g0hZ5wtODP6crNcsJJxQOC5UNK5yuyRmeAK5kwr2N9hKY_IaQjPLJVUBqQ8JEdCGGEyo2fkY0lHP4QRXWxfkeKr7SYb26GnQ01jg3QK-AX9MMW2R-pxRBup87ZvbUdXGxqc7QNtezomHfYx0Lc2NmkQvf2jNbgdvG_sE1LbV3S9ekiywX87c6BxoFyekIPadgFPf_sxeby-2qxu5nf369vV8m7ugMk4N6BBCFQVK1Wpdc6sytOR1qDKuMgYlqpCAMikrpwpMyxTTDmrXI1WWczhmFz8-Ka7XyYMsdi2wWHX2R6HKRScgRYZgGaJCj9UlyIKHuti9O3W-vdEKr7eUGyWxf83JNX574Kp3GK10_yFDp80ToSD</recordid><startdate>201209</startdate><enddate>201209</enddate><creator>AbdelFattah, Kareem R</creator><creator>Eastman, Alexander L</creator><creator>Aldy, Kim N</creator><creator>Wolf, Steven E</creator><creator>Minei, Joseph P</creator><creator>Scott, William W</creator><creator>Madden, Christopher J</creator><creator>Rickert, Kim L</creator><creator>Phelan, Herb A</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201209</creationdate><title>A prospective evaluation of the use of routine repeat cranial CT scans in patients with intracranial hemorrhage and GCS score of 13 to 15</title><author>AbdelFattah, Kareem R ; Eastman, Alexander L ; Aldy, Kim N ; Wolf, Steven E ; Minei, Joseph P ; Scott, William W ; Madden, Christopher J ; Rickert, Kim L ; Phelan, Herb A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c305t-937322e6d0b6b7780a68755a9e641240eb6de333457dc9b4ebb0180dcfea6ae83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Cohort Studies</topic><topic>Craniotomy - methods</topic><topic>Craniotomy - mortality</topic><topic>Critical Illness</topic><topic>Diagnostic Tests, Routine</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Glasgow Coma Scale</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Injury Severity Score</topic><topic>Intracranial Hemorrhage, Traumatic - diagnostic imaging</topic><topic>Intracranial Hemorrhage, Traumatic - etiology</topic><topic>Intracranial Hemorrhage, Traumatic - mortality</topic><topic>Intracranial Hemorrhage, Traumatic - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patient Selection</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><topic>Statistics, Nonparametric</topic><topic>Survival Rate</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Tomography, X-Ray Computed - utilization</topic><topic>Trauma Centers</topic><topic>Treatment Outcome</topic><topic>Unnecessary Procedures</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>AbdelFattah, Kareem R</creatorcontrib><creatorcontrib>Eastman, Alexander L</creatorcontrib><creatorcontrib>Aldy, Kim N</creatorcontrib><creatorcontrib>Wolf, Steven E</creatorcontrib><creatorcontrib>Minei, Joseph P</creatorcontrib><creatorcontrib>Scott, William W</creatorcontrib><creatorcontrib>Madden, Christopher J</creatorcontrib><creatorcontrib>Rickert, Kim L</creatorcontrib><creatorcontrib>Phelan, Herb A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The journal of trauma and acute care surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>AbdelFattah, Kareem R</au><au>Eastman, Alexander L</au><au>Aldy, Kim N</au><au>Wolf, Steven E</au><au>Minei, Joseph P</au><au>Scott, William W</au><au>Madden, Christopher J</au><au>Rickert, Kim L</au><au>Phelan, Herb A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A prospective evaluation of the use of routine repeat cranial CT scans in patients with intracranial hemorrhage and GCS score of 13 to 15</atitle><jtitle>The journal of trauma and acute care surgery</jtitle><addtitle>J Trauma Acute Care Surg</addtitle><date>2012-09</date><risdate>2012</risdate><volume>73</volume><issue>3</issue><spage>685</spage><epage>688</epage><pages>685-688</pages><issn>2163-0755</issn><eissn>2163-0763</eissn><abstract>Scheduled repeat head computed tomography after mild traumatic brain injury has been shown to have limited use for predicting the need for an intervention. We hypothesized that repeat computed tomography in persons with intracranial hemorrhage and a Glasgow Coma Scale (GCS) score of 13 to 15, without clinical progression of neurologic symptoms, does not impact the need for neurosurgical intervention or discharge GCS scores.
This prospective cohort study followed all patients presenting to our urban Level I trauma center with intracranial hemorrhage and a GCS score of 13 to 15 from February 2010 to December 2010. Subjects were divided into two groups: those in whom repeat CT scans were performed routinely (ROUTINE) and those in whom they were performed selectively (SELECTIVE) based on changes in clinical examination. CT scanning decisions were made at the discretion of the neurosurgical service attending physician.
One hundred forty-five patients met the inclusion criteria (ROUTINE, n = 92; SELECTIVE, n = 53). Group demographics, including age, sex, and presenting GCS score were not significantly different. Of SELECTIVE patients, six (11%) required a repeat head computed tomography for a neurologic change, with one having a radiographic progression of hemorrhage (16%) versus 26 (28%) of 92 in the ROUTINE group showing a radiographic progression. No patient in either group required medical or neurosurgical intervention based on repeat scan. The number of CT scans performed differed between the two groups (three scans in ROUTINE vs. one scan in SELECTIVE, p < 0.001), as did the intensive care unit (2 days vs. 1 day, p < 0.001) and hospital (5 days vs. 2 days, p < 0.001) lengths of stay. Discharge GCS score was similar for both groups (15 vs. 15, p = 0.37). One death occurred in the SELECTIVE group, unrelated to intracranial findings. The negative predictive value of a repeat CT scan leading to neurosurgical intervention with no change in clinical examination was 100% for both groups.
A practice of selective repeat head CT scans in patients with traumatic brain injury admitted with a GCS score of 13 to 15 decreases use of the test and is associated with decreased hospital length of stay, without impacting discharge GCS scores.
Diagnostic study, level II.</abstract><cop>United States</cop><pmid>22929497</pmid><doi>10.1097/TA.0b013e318265ccd9</doi><tpages>4</tpages></addata></record> |
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| ispartof | The journal of trauma and acute care surgery, 2012-09, Vol.73 (3), p.685-688 |
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| subjects | Adult Cohort Studies Craniotomy - methods Craniotomy - mortality Critical Illness Diagnostic Tests, Routine Female Follow-Up Studies Glasgow Coma Scale Hospital Mortality Humans Injury Severity Score Intracranial Hemorrhage, Traumatic - diagnostic imaging Intracranial Hemorrhage, Traumatic - etiology Intracranial Hemorrhage, Traumatic - mortality Intracranial Hemorrhage, Traumatic - surgery Male Middle Aged Patient Selection Prospective Studies Risk Assessment Statistics, Nonparametric Survival Rate Tomography, X-Ray Computed - methods Tomography, X-Ray Computed - utilization Trauma Centers Treatment Outcome Unnecessary Procedures Young Adult |
| title | A prospective evaluation of the use of routine repeat cranial CT scans in patients with intracranial hemorrhage and GCS score of 13 to 15 |
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